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Sleep difficulties in children: Top ten tips from a sleep doctor

Sleep difficulties in children: Top ten tips from a sleep doctor

Sleep problems or disorders in children include insomnia (not sleeping enough), hypersomnia (sleeping too much) and parasomnias (odd behaviours during sleep). Many are unique to each individual child and can even be the result of efforts made by the parents - with the best intentions - which actually end up reinforcing the sleep issues. Sleep difficulties in children can also result from skin conditions such as atopic dermatitis or eczema. We interviewed child sleep expert Dr. Sarah Bursaux to learn more about smart sleep behaviours and to get her 10 top tips on how to get your child to sleep.

What exactly is a sleep disorder?

And which sleep disorder does my child have?

A sleep disorder is any disturbance of the duration or quality of sleep. That means difficulty falling asleep and staying asleep, but can also include sleeping but not waking up feeling refreshed.

Beyond medical categories, many sleep disorders are unique to the individual child and Dr. Bursaux is specialised in helping parents identify their own specific behaviour patterns that are intended to help children sleep (e.g. climbing into bed with the child) but which, in the long run, actually create a vicious circle.

What causes sleep problems in children

Why can’t my child get a good night’s sleep?

“Sleep loss is often due to the inner workings of the family unit. Bad habits – which can stem from the best intentions! - simply ‘rub off’ on the child. It’s all about the way in which children learn sleep behaviours, often from their parents. Lots of factors are involved, but it’s very easy to get into a toxic routine. Plus, if the parents are anxious about sleep, the child often will be too. That’s why it’s my job to coach both the child and the parent on how to get a good night’s sleep!”

“Sleep disorders can also be linked to allergies, sleep apnoea syndrome, colic, coughs and colds, otitis or skin pathologies such as atopic dermatitis. Atopic dermatitis or eczema will often keep the child awake. For example, when a child with eczema reaches the end of his sleep cycle, he or she may wake up and start to scratch.”

Atopic dermatitis and sleep

When a child can’t sleep due to itching

A key feature of atopic dermatitis (eczema) that many parents are unaware of is its impact on sleep. But the truth is that sleep disturbance is one of the most common problems in children with eczema.

10-20% of children have eczema and it can really interfere with their sleep. During flare-ups, up to 83% of children have difficulty falling asleep or staying asleep. This issue’s impact on quality of life is not to be underestimated: In multiple studies, the parents of children with atopic dermatitis or eczema single out sleep disturbance as second only to itching as having the most negative effect on their quality of life.

Stress, eczema and sleep

Stress can cause a vicious cycle in children with atopic dermatitis. The more stressed they are, the more their eczema flares up and the more they itch, making it harder for them to get a good night’s sleep. This makes them all the more stressed… and so the cycle continues*.

How does sleep loss affect my child

What is the impact on my child’s everyday life?

Sleep loss in infants and young children can affect their health and wellbeing, but also their performance at school. Recent studies have shown that children with irregular bedtimes up to age three performed less well in maths, reading, spatial awareness and language. In addition, those who regularly got less than 10 hours’ sleep a night were more at risk of developing ADHD**.

“Sleep loss can have all kinds of effects on children: loss of appetite, crying, restlessness, sleepiness and anxiety about going to sleep.

In the case of atopic children with atopic dermatitis or eczema, it can make them more susceptible to infections and more sensitive to pain. It can impair their cognitive ability and disrupt their behaviour, leading to concentration difficulties and emotional problems.

Of course, sleep loss in children does not only affect the child: It affects the whole family, causing anxiety in the parents and siblings, and tensions within the family.”

What would you do to get your child to sleep?

We asked child sleep expert Dr. Sarah Bursaux about some of the crazy things parents have done to get their child to sleep.

“Sleep disorders have such an impact on the child and family that parents are willing to try just about anything and I think I’ve seen it all!

One set of parents had completely shifted their child’s bedtime to late at night. They would give him his supper at 10 pm and bathe him at midnight!

Another pair of parents would drive round and round a ring road until their child finally fell asleep.

I even remember one family switched around all the rooms in the house to accommodate the child with the sleep problem. The father slept in the living room, the child with the sleep troubles slept with her mother in the parents’ bed and the sibling in another room.”

It's clear that childhood sleep problems can have a huge impact on the whole family. Read on for Dr. Bursaux’s insights about managing sleep disorders and her 10 top tips to get your child to sleep, without resorting to crazy solutions!

How to manage childhood sleep disorders

“Almost all sleep disturbances can be managed by a general practitioner, paediatrician or a paediatric psychiatrist, but the most important people are really the parents. Often, problems that initially appeared insurmountable, can be solved in two or three sessions.”

During the first session, which is often quite long, the healthcare professional takes the time to listen to the parents and the child’s story. He/she tries to understand the roots of the sleep disturbance and its main manifestations.

The professional will then spend the next 1-2 sessions explaining the characteristics of normal sleep and propose new ways of dealing with the child’s sleep disorder without prescribing sedatives or hypnotics (sleeping pills).

10 tips to get your child to sleep

1. Communication is key: “Explain why it is time for bed and why sleeping is important. Always listen and answer any questions your child has to reassure him or her before saying goodnight.”

2. Make sleep stress-free: “Sleep should not be seen as a challenge or a struggle for the child. Help your child to see it as something calm and relaxing. One good way of achieving this is giving him or her some autonomy over sleep. You could allow them to choose which pyjamas they wear, or which story you read, etc.”

3. Don’t sleep with your child: “The goal of any sleep therapy is for the child to learn to fall asleep on his or her own, in his or her own bed. Snuggling in with your child can feel like the only thing to do when everyone is exhausted and you are at your wit’s end, but keep your long-term goals in mind! Once you start letting your child share your bed, or once you’ve curled up in theirs, you’ve set a precedent that will only make things harder in the future.”

4. Feed your child at the same time every day: “Consistent meal times help create a consistent routine in general, and that helps with sleep hygiene.”

5. Keep nap times regular: “Children need a sleep routine. Stick to the same nap time every day and don’t let your child nap in the hours before bedtime.”

6. Practice good sleep hygiene: “To sleep well, a child needs a consistent routine such as a bath and story before bed. And you should stick to the same bedtime and wake-up time every day.”

8. Record your progress: “It’s a good idea to use a calendar and stickers to chart your child’s sleep. When he or she gets a good night’s rest, reward your child with one of their favourite stickers. And a week’s worth of stickers might earn your child a treat of his or her choice.”

9. Bedtime stories work: “One of the simplest things you can do to help your child sleep is to read to him or her. This distracts from worry about not sleeping and often allows the child to drift off. Some younger children even enjoy the same story or mini story every night as it helps make bedtimes a ritual. Why not sing the same song or repeat the same comforting phrases every night as you switch off the lights?”

10. Be clear about the rules: “Explain simply and clearly to your child in language he or she understands that once you’ve said goodnight, that means it’s time to sleep. Reassure him or her that you’ll look forward to enjoying a new day together tomorrow morning.”